A common medical problem, particularly for patients advancing in age, is arthrosclerosis or hardening of the arteries. Blockages develop in the arteries and restrict circulation of blood to the limbs or organs. In the legs such blockage of circulation may result in pain in the leg while walking, which may progress to rest pain, tissue necrosis and, finally, gangrene and subsequent amputation. Correction of this condition may require surgical intervention including what is commonly known as femoral-popliteal arterial bypass surgery, whereby a new blood passageway around the area of blockage is established to improve circulation of blood to the lower extremity.
A method for this procedure utilizes an arterial cuff graft for anastomosis to the host artery junction and an artificial bypass graft, such as one made of PTFE. In preparing the arterial cuff graft, it is necessary to evert the arterial cuff graft and, following preparation of the arterial graft, return the graft to its original position.
This procedure was first described by J. Harold Harrison, M.D., W. D. Jordan, M.D., and Antonio R. Perez, M.D., in Surgery, Vol. 61, No. 1, pp. 26-30, January 1967. The instrument described for use in that procedure required insertion of the instrument into the graft and suturing of the graft to the distal portion of the instrument prior to retraction of the instrument for graft reversal.
Certain problems have been noted in the use of the instrument described by Harrison, et al. The Harrison instrument is cumbersome to use, because suturing of the arterial host graft to the instrument is required. Suturing may cause unnecessary damage to the graft. The use of the Harrison instrument requires highly skilled surgical technique in handling to avoid damage to the graft. The need for suturing the graft to the Harrison instrument adds to the difficultly of reverse eversion of the arterial graft cuff once surgical changes to the graft have been performed.
There has thus been a need for a carefully and uniquely designed graft eversion instrument which will adequately, yet without damage, reverse the graft.